On World AIDS Day 2012: Remembering Dr. B. Frank Polk

Dr. B. Frank Polk (1942-1988), physician, epidemiologist, pioneering researcher of HIV/AIDS

Today, December 1st, is World AIDS Day. All over the world, countries are celebrating how far we’ve come in curtailing the spread of HIV/AIDS and how far we need to go. The Sydney Opera House was lit up in a resplendent glowing red against the night sky and a backdrop of red fireworks. Amidst the celebrations, it’s important to take some time to remember a time, not that long ago, when we were all more confused and frightened of this rare, terrifying epidemic.

One of the early pioneers of research into HIV/AIDS and an unsung medical hero is the late B. Frank Polk of Johns Hopkins. In 1982, Dr. Polk was one of the first to dedicate his energy and intellect into finding out more about a new baffling cluster of cases of a sexually transmitted disease cropping up among the gay community. At the time, they called it Gay-Related Immunodeficiency Disease (GRID), trying to pinpoint what it shared with other more well-known diseases.

Initially, at a major research institution like Hopkins, there was some skepticism in the early 80s about the importance of Polk’s research. John Bartlett, a specialist in infectious diseases wondered why Polk wanted to pursue this disease. “What disease? It’s just seven patients.” But Polk was undeterred. “It’s going to be a big one,” he responded.

Through Polk’s tireless efforts to track the symptoms and life cycle of HIV/AIDS, Hopkins and other institutions became more aware of the need to commit funding towards its research at a time when many knew so little about the disease and questioned its importance. I mention Dr. Polk because my mother was in his infectious disease epidemiology course at Hopkins in 1985. She remembers him the way many do, as a tremendously dedicated teacher and physician—bright-eyed, intellectually curious, and patient and incisive in regards to his students and the possibilities for new advances in research.

Three years later, Dr. Polk died of a brain tumor at the age of 46. His obituary in The New York Times describes his dedication and inexhaustible commitment to research, teaching, and lobbying for funding:

Despite the resources being devoted to AIDS research, he often expressed frustration with the slowness of the process: the drugs that turn out to be ineffective, the genetic hypotheses that are not tenable and the blind alleys that must be abandoned.”The only thing to do,” he said in an interview with the publication Public Health, ”is to try again.”

Dr. Frank Polk died before he could see how far his research and hard work helped our understanding and treatment of HIV/AIDS. But his work and legacy certainly live on as we continue to find lasting solutions as to how to treat the disease and improve the lives of those who have it.

The Next Pandemic

A few weeks ago, in the September 22nd issue of The New York Times, David Quammen predicted that the next global pandemic is imminent and is more than likely going to be a zoonotic disease. The variety of zoonotic diseases includes everything from avian influenza, to SARS, to Ebola virus, to AIDS, and more recently, the hantavirus that spread across Yosemite this late summer.

So what’s the next big one, then? Quammen predicts that it might be a variant of the H1N2 strain of influenza carried through pigs at state fairs. “The influenzas are protean and explosive,” he cautions as he describes the virus’s uncanny ability to mutate and adapt to a variety of hosts and environments.

Stephen Soderbergh’s 2011 medical thriller Contagion explores the crisis that can unfold with a zoonotic outbreak. Lo and behold, the disease that Gwyneth Paltrow dies from in the beginning of the film has a pig vector that’s derived from an infected bat, all of which emerges out of China. A cross between SARS, swine fever, and brucellosis. The movie dramatizes in that familiar grainy documentary-style Soderbergh way the ghastly consequences of what can happen when a carrier of an infection is slow to realize their symptoms. So what can anyone do to protect themselves in the wake of an outbreak?

There isn’t a great deal more to do besides being highly vigilant of your personal hygiene and being aware of the animals you come into contact with, but recognizing the early cold and flu like symptoms is an important starting point so that you can seek medical help at the early stages. An Australian public health site has some effective steps laid out:

“Preventing Zoonoses”: http://www.daff.qld.gov.au/4790_11448.htm

To read more of David Quammen’s  “Anticipating the Next Pandemic,” go to

Slavery is a Problem Now More than Ever

Girls at work in a red light district in India

There are more than 30 million slaves in the world today. More than any other point in human history, according to the UNCHR and UNICEF. Yesterday, the U.S. President gave a speech at The Clinton Global Initiative where he vowed he would use all resources to end the global trafficking of children and women. We don’t often realize that the clothes we might wear or the chocolate we might eat are made by young people sold into slavery.

In South Asia alone, millions of people from India, Bangladesh, Nepal and Pakistan are trafficked for forced labor or prostitution. The traffickers are often the people the children know well–neighbors or relatives.

From the map, we can see the highest incidence of trafficking in Russia, Central Asia, Eastern Europe, and then in South Asia and Latin America. A mainstream movie like Taken opened our eyes to the seamy underbelly of trafficking in glittery Paris, while Slumdog Millionaire showed us what it means to poor, powerless and young in urban India. So, what can anyone do to make a difference and stop this ongoing crime? Many sites have a step by step guide of what we can do to be more aware of people who are traffickers and those who are trafficked. A major step is lobbying congressmen and industries to enact laws and measures that will target traffickers. With stricter laws and more rigorous border patrol at high-risk areas it’s harder for people to be trafficked out of a country without their consent.

Check out the Not For Sale campaign, where you can see what might be done

Homepage

In India There’s More Cell Phones than Toilets

This is one of the big problems of aid management in India. A report released by the World Bank in 2010 said that the lack of toilets and proper sanitation in India costs a whopping $54 billion annually. The situation now seems to be no better. There are an estimated 450,000 deaths out of 575 million cases of diarrhea every year in India. Due to the lack of proper sanitation and facilities, millions of people in rural and urban areas resort to defecating in public, often along railroad tracks.

This creates long-term public health problems, of course, with illnesses that arise from diarrhea, malaria, trachoma and intestinal worms, but the lack of sanitation leads to the agonizing social situation for anyone’s dignity, especially for women. When so much is spent on programs related to education and empowerment of the poor, you’d hope that some more money would be directed toward having more sanitation facilities across the country, so people could feel empowered in little, but significant ways.

The journalist Adam Yamaguchi did a great profile on this, that he called The World’s Toilet Crisis, which you can check out here

 

Hoarding, Rodents, and The Yosemite

Glenn Dean, a National Parks Occupational Safety and Health Specialist, inspects tent cabins for mice entry points at Curry Village at Yosemite National Park on Tuesday, September 4th.

Not cleaning out your basement can occasionally lead to some devastating consequences. Last week, the CDC reported an outbreak of hantavirus.

The National Park Service announced that there were 8 confirmed cases of Hantavirus Pulmonary Syndrome (HPS) in visitors who stayed at Curry Village in Yosemite National Park since June of this year. Public health officials believe that these visitors may have been exposed to hantavirus while staying at the Signature Tent Cabins in Curry Village.

Hantavirus is carried by mice, in their urine and feces, and is an airborne infection. The mice not suffer from the disease but humans do. Humans are thought to become infected when they are exposed to contaminated dust from the nests or droppings of mice. Contaminated dust is frequently encountered when working in or cleaning long-vacated cabins, sheds, or other enclosed areas. Infection is not passed between humans.

It affects the lungs and the symptoms resemble those of influenza–fever, chills, nausea, vomiting. The C.D.C. Web site quotes one survivor as saying that it felt as if he had a “tight band around my chest and a pillow over my face.” The worst case scenario is respiratory failure and internal bleeding.

The last time an outbreak of hantavirus made the news it was in 1993 concerning an outbreak on an Indian reservation in the Four Corners area of the southwest. It was due to a case of hoarding in trailers and tents where mice bred in dark, crowded little rooms.

As of now, five people are ill from the Yosemite outbreak and three have died. Health officials predict that up to 10,000 guests could have been exposed to hantavirus from  sleeping in the cabins since June 10.

Death Toll in Syria over 17,000

An opposition group that documents human rights violations in Syria says more than 17,000 people have been killed since the uprising against President Bashar Assad began in March 2011. And many more are likely to die if an agreement isn’t reached between opposition forces and Assad regime.

What enormous health problems will the population and aid workers have to contend with in the coming months? The World Health Organization is already facing critical medicine shortages in Aleppo and Homs. How will those who are injured, the vast majority who are civilians and many of who are children, receive the basic treatment they need? The situation in Syria is already paralleling and soon may surpass the devastation and loss of life during the Spanish Civil War.

From the UN News Center: “Syria experiencing critical shortages in medicines”

http://www.un.org/apps/news/story.asp?NewsID=42641&Cr=syria&Cr1

HIV-Infected Organ Transplants

HIV research, treatment, and advocacy groups are lobbying members of Congress to amend current law and allow transplantation of organs from HIV-infected donors to HIV-infected recipients. They are calling to amend the National Transplant Act, passed in 1984, which reflects the profound lack of knowledge of HIV/AIDS at the time when it was written. HIV has become a manageable chronic disease and patients with HIV have longer life spans and are vulnerable to other chronic diseases associated with older age, such as kidney failure and liver failure–conditions for which organ transplantation is often the standard treatment.

JAMA, August, 8, 2012, Mike Mitka

 

Tony Cunning, 48, of Milwaukee, got a kidney transplant last month at UW Hospital. He is one of the first three HIV-positive patients to receive an organ transplant in Wisconsin.

Overpopulation and Family Planning

In Nigeria: Muriana Taiwo, 45, explained that it was “God’s will” for him to have 12 children by his three wives, calling each child a “blessing” because so many of his own siblings had died.

What are the global consequences to overpopulation? In the United States, as access to family planning services becomes increasingly more jeopardized across the country, what can be said of other countries where access is even more limited?

Last November, the United Nations announced that the global population had breached seven billion and would expand rapidly for decades, taxing natural resources if countries cannot better manage the growth.

In an April issue of the NY Times, Elizabeth Rosenthal, wrote that,

“Across sub-Saharan Africa, alarmed governments have begun to act, often reversing longstanding policies that encouraged or accepted large families. Nigeria made contraceptives free last year, and officials are promoting smaller families as a key to economic salvation, holding up the financial gains in nations like Thailand as inspiration.

Nigeria, already the world’s sixth most populous nation with 167 million people, is a crucial test case, since its success or failure at bringing down birthrates will have outsize influence on the world’s population. If this large nation rich with oil cannot control its growth, what hope is there for the many smaller, poorer countries.”

A change in attitude and perception has to occur concerning family size, gender equality, and the value of the education of young people across Sub-Saharan Africa and other parts of the world.

To read the rest of Elizabeth Rosenthal’s article:

 

March 22: World Water Day

Today is World Water Day. Multinational organizations have set aside this day officially to remind us that the access to clean and safe water for much of the world’s population is becoming a scarce commodity. More often than not, the poorest and the most underserved populations in remote rural areas face the crisis in the worst way.

Matt Damon’s non-profit water.org tackles water accessibility issues in Haiti and he’s just put out a video on Youtube. A lot of productive work can be done so that we don’t end up in that crack-pot apocalyptic scenario in Waterworld.

 

Foreign Aid from India: There’s a New Sheriff in Town

There was an illuminating article in The Economist about emerging economies like India and Brazil setting up a formal infrastructure for foreign aid and development. China has already been a big player for the past five years. Evidence that India is begin to grow as a major global player in international foreign poliy.

CHARITY BEGINS ABROAD

Aug 13th 2011

BETWEEN 1951 and 1992 India received about $55 billion in foreign aid, making it the largest recipient in history. Now it seems on the verge of setting up its own aid-giving body. A spokesman for the foreign ministry says the government is in “active discussions” to create an India Agency for Partnership in Development (IAPD), an equivalent of America’s Agency for International Development (USAID) or Britain’s Department for International Development (DFID). Bureaucrats in other ministries are dragging their feet but Gurpreet Singh of RIS, a Delhi think-tank, says the government will announce the body within months, and give it $11.3 billion to spend over the next five to seven years.

India’s switch from the world’s biggest recipient to donor is part of a wider change shaking up foreign aid. Ten years ago the vast majority of official development assistance came from about 15 rich industrialised countries that are members of the Development Assistance Committee (DAC), a 50-year-old club of the aid establishment. Even today, America remains the largest single donor, dishing out $31 billion in 2010.

But second on the list, if reports monitored by New York University’s Wagner School are to be believed, would be China, which gave away $25 billion in 2007. (Statistics on aid from new donors are dodgy and the line between aid and trade is blurred; by another count China’s officially reported aid was only $1.9 billion in 2009.) Brazil, which is also thinking about setting up its own aid agency, gives up to $4 billion a year of assistance, broadly defined. That would put it on a par with Sweden, Italy—or Saudi Arabia, another big donor outside the establishment club. If India gives around $2 billion a year, it would rank with Australia or Belgium.

According to a new report by a non-governmental organisation called Global Humanitarian Assistance, aid (conservatively defined) from non-DAC countries rose by 143% in 2005-08, to $11.2 billion, before falling during the financial crisis. Aid from the BRICs (Brazil, Russia, India and China) more than doubled. The establishment donors’ aid monopoly is finished.

Aid from upstart donors is not exactly new. India has trained poor countries’ civil servants for decades, in a programme called Indian Technical and Economic Co-operation (ITEC). The Soviet Union and Maoist China spent billions helping poor client states during the cold war. What is new is that these programmes are expanding rapidly (in the case of China and Russia, after a steep fall). ITEC will train 5,500 people from 120 countries this year, says Vishnu Prakash of the foreign ministry (up from 3,400 in 2005). Before 2007, Russia spent about $100m in aid. This rose to an average of $422m a year between 2007 and 2010, according to the finance ministry.

Over the past decade China has evolved from a net recipient to net donor. A milestone was reached in 2005, when the World Food Programme dispatched its last shipment of grain after donating to China for some 25 years. This year Britain’s DFID wound up its bilateral aid programme in China. At the same time, China has become a far bigger donor. Wen Jiabao, the prime minister, has promised that in 2010-13 China will provide $10 billion in low-interest loans to African countries, bolster the China-Africa Development Fund by $1 billion (bringing it to $5 billion) and cancel debt owed by highly indebted countries with which China has diplomatic relations. In April this year the Chinese government issued its first white paper on its foreign-aid programme. The amount budgeted for aid had “increased rapidly” since 2000, it said, with growth of nearly 30% a year between 2004 and 2009.

The new donors stress that their aid is different from that provided by the West. They reject the traditional idea of beneficent donor helping indigent client and claim to be engaged in “South-South co-operation”. China says the “first principle” of its development assistance is “equality and mutual benefit in providing aid”. In practice, though, the real differences with the West lie elsewhere.

Most new donors give priority to their neighbours. Saudi Arabia gives much of its aid to other Arab states. During the 2009 financial crisis Russia helped out the struggling countries in its “near abroad”, including Tajikistan and Armenia. Russia keeps afloat the thuggish and autocratic regime in Belarus through low energy prices and gives roughly $1.5 billion to Abkhazia and South Ossetia, areas which have broken away from Georgia and are recognised by Russia as sovereign states.

The Indian government sees aid as a way of improving miserable ties with neighbours. A symbolic offer of $25m to Pakistan a year ago, via the United Nations, to assist in flood relief, was unlikely to have melted many hearts. But huge investments in hydropower in Bhutan (in return for the guaranteed supply of fixed-price electricity into India’s grid) helped both countries. India would now like to do something similar with Nepal. India extends large, soft loans to curry favour with a friendly regime in Bangladesh and is paying for post-war reconstruction in Sri Lanka. With Western support, it is also building roads, a power grid and a new parliament building for its ally, Hamid Karzai, in Afghanistan, where India is the fifth-largest donor.

A lot of new aid is also given partly in support of commercial interests. The Saudi government says one of its aims is to promote non-oil exports. But the biggest pursuer of such interests is China. Many of its aid projects help build infrastructure that benefits Chinese investment. It has helped rebuild the Tanzam railway, for example, linking Zambia’s copper belt, where China has large projects, and Dar-es-Salaam, where it has modernised the port. The white paper seeks to counter Western views that much of its aid goes to feed its appetite for oil and minerals. It says only 8.9% of concessional loans have been used to support the extraction of such resources. But it gives no details. Much of the 61% of loans for transport, communications and power may also help mining efforts.

The big unresolved question for the new donors, argues Duncan Green, head of research at Oxfam, an NGO, is how far they adopt the policies and institutions of Western donors or how far they go their own way, blurring boundaries between aid and investment. There have been one or two nods towards Western ideas recently. The BRICs are giving more through multilateral channels, moving away from their usual government-to-government help. China’s white paper uses Western-style language about “increasing recipient countries’ capacity”. But by and large the new donors think their model of giving aid is better. As their contributions soar and Western ones stagnate or shrivel, the aid world is seeing genuine competition.